pathology of breast cancer surgery showed T1= 4mm ,N0 (SLNB 2 negative nodes), ER+, PR+, HER2 +++, KI67= 30% Lymphovascular is not invaded,perinural invasion is not detected.
pre menopause and metastatic work up is negative, no familial history of cancer.
which adjuvant do you recommend?
I am not a medical doctor but according to my knowledge in the field of cancer biology pre-menopausal women who are ER+ and PR+ usually receive hormonal therapy (including aromatase inhibitor).
HER-2 +++ status means that the patient may be also needs treatment (one year?) with Herceptin (Trastuzumab) or some other targeted anti-Her-2 agent.
The medical oncologists will find the best way for treatment and the patient has to follow strictly the treatment scheme.
All of us know that " the enriched subtype to receptor 2 human epidermal growth factor (HER2), without adjuvant systemic therapy, has a lower disease-free survival and higher recurrence rate, but it benefits from target-specific therapies." "Additionally, according to insights of respondents thought-leaders, pertuzumab plus trastuzumab and docetaxel and T-DM1 plus pertuzumab have demonstrated the potential to increase overall survival of patients, which was not improved by drug-treatment since the approval of trastuzumab on a decade ago"
Specifically for this patient (T1aN0M0) could be offered for adjuvant treatment, the following options to be chosen by the patient after all the necessary information:
a)tamoxifen citrate only. 20 mg / day for 10 years
b)Hysterectomy more oophorectomy more tamoxifen citrate. 20 mg / day for 10 years
c)4AC + 4T more transtuzumab more tamoxifen citrate. 20 mg / day for 10 years.
d) 4AC + 4T more transtuzumab plus Hysterectomy more oophorectomy more tamoxifen citrate. 20 mg / day for 10 years.
e)pertuzumab plus trastuzumab and docetaxel plus Hysterectomy more oophorectomy more tamoxifen citrate. 20 mg / day for 10 years.
There is a dilemma for this patient , ki 67 is high so we can consider her for chemo and Herceptin ,although I personally do not like over treatment for hormone positive breast cancers .Does she have any plan for future child bearing/
Dear Dr Radostina Alexandrova, Angelo , Alavi
Many thanks for your replies
In my opinion, there are some dangerous factors in my patient such as young age, positive HER2 and hi KI67 that predict a aggressive biology of tumour .
so the recurrence possibility is remarkable and i myself recommend to take adjuvant chemotherapy plus herceptin followed by radiotherapy because of BCS and finally endocrinotherapy like Tomxifen.
Dear Dr Alavi
thanks again for your reply
patient familial planing is complete.
Dear Dr Habibollah
You are definitely right . If she will not made adenomastectomy, beyond what is proposed, the radiotherapy is authoritative.
congratulations
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